近侧骨折段向前成角移位的股骨粗隆间骨折治疗经验  

Treatment of intertrochanteric fractures with forwardly and angularly displaced proximal part

作　　者：王敬博[1] 于树军[1] 李辰[1] 臧加成[1] 王裕民[1] WANG Jingbo;YU Shujun;LIChen;ZANG Jiacheng;WANG Yumin(No.1 Department of Hip Traumatology,Tianjin Hospital,Tianjin,300211,P,R.China)

机构地区：[1]天津医院创伤髋关节一病区,天津300211

出　　处：《中国修复重建外科杂志》2018年第9期1162-1166,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：天津市卫生计生委重点公关项目(16KG143)~~

摘　　要：目的探讨近侧骨折段向前成角移位的股骨粗隆间骨折的特点及治疗措施。方法 2015年3月—2016年3月采用手术切开复位、髓内钉固定治疗40例近侧骨折段向前成角移位的股骨粗隆间骨折患者。男11例,女29例;年龄56～87岁,平均75.7岁。致伤原因:交通事故伤1例,摔伤39例。体质量指数18.9～33.8 kg/m2,平均24.3 kg/m2。受伤至入院时间2～360 h。骨折按照AO-OTA分型:A1.2型7例,A1.3型1例,A2.1型6例,A2.2型9例,A2.3型12例,A3.2型2例,A3.3型3例。记录患者入院时、术前以及术后最低血红蛋白(haemoglobin,Hb)值,住院期间输血量和手术显性出血量。采用简明健康调查量表(SF-36量表)评估患者伤前及术后12周生活质量,疼痛视觉模拟评分(VAS)评估入院时及术后2 d疼痛程度。根据术后X线片及临床检查判断骨折愈合情况。术后12周采用Harris评分评价患侧髋关节功能。结果患者入院时Hb为(114.33±14.93)g/L,术前最低Hb为(99.10±16.48)g/L,差异有统计学意义(t=9.134,P=0.000)。11例术前输血(520.00±269.98)m L。手术显性出血量(373.08±154.68)m L,术中输血量为(569.23±207.94)m L。术后患者最低Hb为(105.41±13.36)g/L,8例患者术后再次输血(500.00±185.16)m L。术后3 d按照改良Baumgaertner法评价骨折复位情况:优16例,良18例,差6例。40例获随访,随访时间12～15周,平均12.8周。术后切口无感染发生。术后2 d VAS评分为(3.2±0.5)分,较入院时的(8.2±0.5)分显著改善(t=37.500,P=0.000)。术后12周骨折均愈合;患侧髋关节Harris评分为(82.5±6.9)分;SF-36量表评分为(51.4±11.5)分,较伤前(54.9±11.5)分显著降低(t=18.901,P=0.000)。术后4例出现谵妄,8例感染肺炎,5例泌尿系统感染,2例出现静脉血栓形成,均经相应处理后治愈。结论近侧骨折段向前成角移位的股骨粗隆间骨折是一种难复位、不稳定型骨折,术中需要通过辅助器械达到骨折良好复位,解剖对位是取得良好疗效的首要条件Objective To explore the characteristics and treatment of intertrochanteric fracture, which the proximal part displaced forwardly and angularly. Methods Between March 2015 and March 2016, 40 patients with intertrochanteric fracture with forwardly and angularly displaced proximal part were treated with open reduction and intramedullary nailing fixation. There were 11 males and 29 females with the age of 56-87 years（mean, 75.7 years）. The causes of injury included traffic accident in 1 case and fall in 39 cases. The body mass index was 18.9-33.8 kg/m2（mean,24.3 kg/m2）. The time from injury to admission was 2-360 hours. The type of fracture according to AO-OTA classification was A1.2 type in 7 cases, A1.3 type in 1 case, A2.1 type in 6 cases, A2.2 type in 9 cases, A2.3 type in 12 cases, A3.2 type in2 cases, and A3.3 type in 3 cases. The haemoglobin（Hb） value at admission and the lowest values before and after operation were recorded; the amount of transfused-blood during hospital stay and visible blood loss around operationwere recorded. The short-form 36 health survey scale（SF-36） before injury and at 12 weeks after operation were recorded for evaluating the quality of living; the visual analogue scale（VAS） score at admission and at 2 days after operation were recorded for evaluating the degree of pain, the fracture union was evaluated by X-ray film and clinical examination, and the Harris hip scale were used to evaluate the injuried hip function at 12 weeks. Results The lowest Hb value before operation was（99.10±16.48） g/L, which was significantly lower than that at admission[（114.33±14.93） g/L]（t=9.134,P=0.000）. Eleven patients were treated with blood transfusion at amount of（520.00±269.98） m L before operation. The amount of transfused-blood during operation was（569.23±207.94） m L, and intraoperative blood loss was（373.08±154.68） m L. The lowest Hb value was（105.41±13.36） g/L after operation, and 8 patients were treated with second blood transfusion at amount

关 键 词：股骨粗隆间骨折 向前成角移位 解剖对位 复位 

分 类 号：R687.3[医药卫生—骨科学]